Differences of The Number of Maternal References In Semarang Public Health Center Based on MEOWS Scoring System

Background: The maternal mortality rate in Semarang is 121.5 per 100,000 live births, the second-highest in Central Java. The early warning system with the Early Warning Score and the maternal emergency early warning system (PDKM) still has various shortcomings to reduce MMR.Objective: This study aims to prove the effectiveness of the application of the PDKM Modified Early Obstetric Warning System (MEOWS) as an assessment of the risk of pregnancy in primary health facilities to reduce MMR in Semarang.Methods: The study was conducted on all pregnant women who came to Tlogosari Wetan, Tlogosari Kulon, Bandarharjo, and Bangetayu public health center in Semarang and were willing to participate in the study and were referred to government hospitals using national health assurance BPJS. Sampling was done by cluster random sampling by dividing the intervention and control groups. The study used a pretest-posttest control group design method by comparing the use of the MEOWS and the Poedji Rochjati Scorecard (KSPR) to the number of public health center referrals in Semarang. The data obtained will be analyzed statistically with the bivariate test, Mann-Whitney difference test, relative risk reduction, and absolute risk reduction.Results: The results showed that 21 of 43 (48.8%) patients were referred to the control group and 26 of 36 (72.2%) patients were referred to the intervention group. Mann-Whitney test of the number of referrals after the intervention within 3 months showed significant results (p = 0.033; p <0.05). There was an increase in the number of maternal referrals at the public health center in Semarang after the implementation of the MEOWS score by 1.48 times compared to using the KSPR (RR : 1.48 ; 95% CI : 1.02 – 2.13).Conclusion:The use of the MEOWS score can increase awareness of potential referrals and is associated with complications in patients.Background: The maternal mortality rate in Semarang is 121.5 per 100,000 live births, the second-highest in Central Java. The early warning system with the Early Warning Score and the maternal emergency early warning system (PDKM) still has various shortcomings to reduce MMR.Objective: This study aims to prove the effectiveness of the application of the PDKM Modified Early Obstetric Warning System (MEOWS) as an assessment of the risk of pregnancy in primary health facilities to reduce MMR in Semarang.Methods: The study was conducted on all pregnant women who came to Tlogosari Wetan, Tlogosari Kulon, Bandarharjo, and Bangetayu public health center in Semarang and were willing to participate in the study and were referred to government hospitals using national health assurance BPJS. Sampling was done by cluster random sampling by dividing the intervention and control groups. The study used a pretest-posttest control group design method by comparing the use of the MEOWS and the Poedji Rochjati Scorecard (KSPR) to the number of public health center referrals in Semarang. The data obtained will be analyzed statistically with the bivariate test, Mann-Whitney difference test, relative risk reduction, and absolute risk reduction.Results: The results showed that 21 of 43 (48.8%) patients were referred to the control group and 26 of 36 (72.2%) patients were referred to the intervention group. Mann-Whitney test of the number of referrals after the intervention within 3 months showed significant results (p = 0.033; p <0.05). There was an increase in the number of maternal referrals at the public health center in Semarang after the implementation of the MEOWS score by 1.48 times compared to using the KSPR (RR : 1.48 ; 95% CI : 1.02 – 2.13).Conclusion: The use of the MEOWS score can increase awareness of potential referrals and is associated with complications in patients.

Case Report: Early Recognition and Repair of Distal Iatrogenic Ureteral Injury During Laparoscopic Rectal Surgery

Background: Ureteral injury is an uncommon complication of the colorectal procedure. The colorectal procedure is the second most common cause of ureteral injury. The laparoscopic approach for colorectal surgery has contributed to the increase of ureteral injury. Delayed diagnosis of the iatrogenic ureteral injury is associated with higher morbidity. However, the early diagnosis of ureteral injury during the operation is difficult. We presented an early recognition and laparoscopic repair of iatrogenic ureteral injury during laparoscopic rectal cancer surgery cases and the strategy for recognizing and managing that injury for the surgeon.Case Presentation: A Male, 34 years old, had an iatrogenic ureteral injury during laparoscopic low anterior resection for rectal cancer. The left distal ureter was transected by an energy device. The diagnosis of ureteral injury was prompt. The repair of the ureter was done endo-laparoscopically. The patient had an uneventful recovery and was discharged on day 6 after surgery.Conclusion: The iatrogenic ureteral injury, although uncommon, is a serious complication of laparoscopic colorectal surgery. Direct visual identification of the distal ureter is mandatory in every rectal surgery. The iatrogenic ureteral injury is not an indication for open conversion when there is an adequate resource to do the endo-laparoscopic ureteral repair.

Case Report: Pregnancy with Fetal Hydrathorax

Background: Cases of fetal hydrothorax (FHT) are rare, with an occurrence probability of 1 in every 10,000-15,000 pregnancies. The condition may remain undiagnosed, and the fetus may be aborted, or death may occur soon after birth in outlying hospitals before transfer to a tertiary care center. The incidence rate of FHT is higher in males than females (2:1). One of the most effective methods of diagnosing fetal hydrothorax is sonography. Three forms of currently available treatments are: thoracentesis, thoracoamniotic shunting (TAS), and thoracomaternal cutaneous drainage. Fetal outcomes could be improved by performing the Extrauterine Intrapartum Treatment (EXIT) procedure.Case Presentation: We present two cases of first pregnancy primary FHT. In the first case, a 24-year-old woman was diagnosed with asymptomatic FHT in the 28th week of gestation without any prior history. In the second case, a 22-year-old woman with poor medical history was diagnosed in the 35th week of pregnancy and was experienced difficulty of breathing. Both pregnancies were delivered by cesarean section based on obstetric indications. Thoracentesis was performed on both neonates, and pathological examination of the pleural fluid was conducted. However, they died shortly after birth.Conclusion: The EXIT procedure is still a challenging method. A fetus with FHT is at significant risk of pulmonary hypoplasia and respiratory distress following delivery. Early diagnosis and intervention of FHT are vital to ensure a good prognosis. Approaching multidisciplinary groups, providing supportive diagnostic facilities and financial support is essential in improving fetal outcomes and preventing FHT in subsequent pregnancies.

The Relationship Between Severity of Periodontitis With the Degree of Atherosclerosis in Ischemic Stroke Patients

Background : Periodontal diseases affect up to 80% of the global population. Periodontitis is a long-term inflammatory disease that affects the soft and hard tissues around the teeth. It may also play a role in the pathogenesis of atheroma formation and is associated with cerebrovascular disease. The Carotid Intima Media Thickness (CIMT) is a good marker for detecting early and progressive atherosclerosis. Several hypotheses link chronic infectious diseases, including periodontal tissue disease, to the atherosclerosis process and are risk factors for stroke.Objective : To determine the relationship between the severity of periodontitis and the degree of atherosclerosis in ischemic stroke.Methods : This is an analytic observational study with a case-control approach. Subjects were ischemic stroke patients with inclusion criteria. Analyzed the severity of periodontitis with Miller’s Mobility Index (MMI), the degree of progression of atherosclerosis assessed by measuring the CIMT using an ultrasound device or B mode to detect the presence and progression of atherosclerosis.Results : 54 subjects with a mean age were 63,43 ± 7,19 years, and the dominant sex was male. There was a significant relationship between severity of periodontitis ( P : 0,011, OR : 3,425, CI 95% 1,332-8,807) and type of profile lipid triglyceride ( P : 0,027, OR : 6,840, CI 95% 1,242-37,676) to Carotid intima media thickness.Conclusion : There is an association between the severity of periodontitis and the degree of atherosclerosis. Severe periodontitis is related to the increases of CIMT, which is a marker of atherosclerosis, a risk factor for stroke.

The Correlation between Perceived Social Support with Suicide Ideation

Background: Based on data from WHO in 2015, it shows that the death rate due to suicide in the world was recorded to have increased by 23.2% compared to 2009. Research in 2016 shows that the largest age range who experienced suicide was from 15-29 years. Many things are predicted to be a protective factor against suicide, including social support. Research on suicide protection factors is useful in preventing the increasing number of suicides.Objective: To analyze the correlation between perceived social support with suicidal ideationMethods: This research is a quantitative study with cross sectional design. Samples were taken from vocational school and academy in Semarang, who met the inclusion and exclusion criterias. The sample selection was carried out by the simple random sampling method. This research used the Indonesian version of the SSI (Scale of Suicide Ideation) and the MSPSS (Multidimentional Scale of Perceived Social Support) questionnaires.Results: It was found that the prevalence of high suicidal ideation score was 50.8% while the low suicidal ideation score was 49.2%. There was a significant correlation between suicidal ideation with perceived of family support (p = 0.002) and peer support (p = 0.050). Meanwhile, there was no significant correlation between the suicidal ideation and the support from significant others (p = 0.154). Conclusion: There was a correlation between perceived of family and peer support with suicidal ideation

Difference of Schirmer Test Results Before and After Using Smartphones with Various Screen Brightness Levels

Background : The use of smartphones and other digital devices such as laptops and tablets is familiar in Indonesian society. Excessive uses of the devices are associated with dry eye syndrome and tear film dysfunction. The intensity of blue light when penetrating the eye is believed to affect tear film stability. Thus it will encourage tear evaporation which proved by Schirmer test.Objective : To find out the difference of Schirmer test results before and after using a smartphone with various screen brightness levels.Methods : This study used pretest-posttest quasi-experimental study. The research subjects were students of the Faculty of Medicine, Diponegoro University (n = 30) who were selected by purposive sampling. In this study, the research subjects used smartphones for an hour with a predetermined screen brightness level, with the same room lighting. Before and after treatment the subject was measured the quantity of tears using the Schirmer test. Data were analyzed using the Wilcoxon test, Mann Whitney U test, and Kruskal Wallis test.Results : The average pretest result on low brightness was 25,60 ± 9,44 and the post-test result was 17,60 ± 8,45. The pre-test result on medium brightness was 27,90 ± 9,46 and the post-test result was 24,80 ± 10,46. The pre-test result on high brightness was 23,60 ± 6,80 and the post-test result was 19,10 ± 7,95. The Schirmer test results before and after using smartphones with low brightness showed a significant different (P<0.05) and there was no significant difference for the pre-post test using smartphones with medium and high brightness. Comparison of Schirmer test results on low, medium and high screen brightness did not show a significant difference.Conclusion : There is no significant difference between the Schirmer test results among low, medium and high screen brightness after one hour of smartphone usage.

Pregnancy with Hypothyroid Secondary to Treatment of Thyroid Carcinoma: A Case Report

Background: Thyroid malignancy is one of the most common malignancies in women of reproductive age. One of the normal physiological change in pregnancy is an increase in total maternal thyroid levels. According to 2015 DATIN information, the prevalence of hypothyroidism in women of reproductive age was 2.2%. Method of delivery in patients with thyroid disorders are mostly by cesarean section due to complications of the mother and/or fetus. Fetal outcome usually associated with low birth weight and poor APGAR Score.Objective : Reporting a case of pregnancy with hypothyroidism secondary to thyroid carcinoma treatmentCase: A 37-year-old woman Gravida 3 Parity 2 Abortion 0 with 18 weeks pregnancy after thyroid ablation treatment with a history of Papillary Thyroid Carcinoma – Follicular Variant, following a complete thyroidectomy in August 2016. The patient was given 6-dose ablation therapy, the last therapy was performed in April 2019. On clinical examination, the patient have no sign and symptoms suggesting hypothyroidism. On laboratory examination, the thyroid stimulating hormone (TSH) level was increased. Levothyroxine dosage was adjusted until the patient in euthyroid status in the early 3rd trimester of pregnancy until the delivery period. The fetal examination suggests that the Bio-Physical Profile was normal according to gestational age. The patient underwent vaginal delivery following 38 weeks of gestation with good maternal outcomes and low birth weight neonatal outcomes, no thyroid nodules, and slightly increased thyroid function.Conclusion : Management of counselling about preconception, contraception, and initial screening of patients with a history of thyroid carcinoma are the initial steps to help a better outcome in pregnancies with thyroid disorders.

Efficacy of Vitamin B1, B6, and B12 Forte Therapy in Peripheral Neuropathy Patients

Background: Peripheral neuropathy can be caused by diabetes mellitus, nutritional deficiencies, entrapment or Carpal Tunnel Syndrome (CTS), and idiopathic.Objective: To determine the therapeutic efficacy of Vitamin B1, B6, and B12 forte in relieving symptoms of peripheral neuropathy.Methods: This was pre- and post-experimental study involving patients with moderate peripheral neuropathy (Toronto Clinical Neuropathy Score [TCNS] ≥6 and Michigan Neuropathy Screening Instrument [MNSI] ≥7) taken from outpatient neurological clinic of Dr. Kariadi Hospital, Semarang. The patient was prescribed Vit B1 100 mg, B6 100 mg, and B12 5000 mcg once daily for 2 months. Evaluation of the numerical pain rating scale in the form of VAS and Total Symptom Score (TSS) was conducted at the first and second month. The VAS score difference test was conducted with the Wilcoxon test and TSS with the Post Hoc test and considered significant if p <0.05.Results: There were 30 patients aged 18 - 65 years, consisted of 70% female and 30% male. The etiology of peripheral neuropathy were idiopathic (40%), CTS (26.7%), DM (23.3%), and HNP (10%). There were significant differences of the VAS scale and TSS at every evaluations.Conclusion: Administration of VitB1, B6, and B12 forte relieved symptoms of moderate peripheral neuropathy with improvement of VAS and TSS scores

The Effect of Using Blue Light Filter Feature on Smartphones with Asthenopia Occurrence

Background: Smartphone users can be found in almost every class society in Indonesia. Excessive use of smartphones and the blue light emitted by smartphones play an important role in causing asthenopia symptoms. Smartphone development companies have developed a blue light filter feature, which is expected to reduce the incidence of Asthenopia symptoms.Objective: To evaluate the Asthenopia questionnaire's comparison results before and after smartphone use with various levels of opacity in the blue light filter.Methods: This study used a quasi-experimental pre-posttest study. The research subjects were students of the Faculty of Medicine, Diponegoro University (n = 30), selected by purposive sampling. In this study, research subjects saw an hour-long smartphone with a predetermined opacity level for the blue light filter, with the same room lighting. Before and after the treatment, the subjects were asked to fill out the Asthenopia questionnaire. Data were analyzed using the Wilcoxon test, Mann Whitney U test, and Kruskal Wallis test.Results: The results of the Asthenopia questionnaire before and after using a smartphone with a blue light filter opacity level of 0% and 100% showed a significant difference in results (p <0.05), and there was no significant difference for the pre-posttest using a smartphone with a blue light filter with 50% opacity level. The comparison results of the Asthenopia questionnaire between smartphone use with the opacity level of the blue light filter 0% and 50% only showed a significant difference in sore/aching eye symptoms. The comparison results of the Asthenopia questionnaire between smartphone use with the opacity level of the blue light filter 50% and 100% only showed a significant difference in sleepy eye symptoms. The comparison results of the Asthenopia questionnaire between smartphone use with the opacity level of the blue light filter 0%, 50%, and 100%, did not show a significant difference.Conclusion: There were no significant differences between the Asthenopia questionnaire results with 0%, 50%, and 100% opacity blue light filters after one hour of smartphone use.

The Correlation Between Cobb’s Angle and Pedicle Rotation in Adolescent Idiopathic Scoliosis After Surgical Treatment

Background: Adolescent Idiopathic Scoliosis (AIS) is a 3-dimensional deformity that involves not only curve in the coronal and sagittal planes but also rotation of vertebrae based on pedicle rotation. The Cobb’s angle is the gold standard for measuring the lateral curve that could show severity of the spine deformity. The Cobb’s method only evaluate the lateral curve,and the method to determine the pedicle rotation can be used the Nash and Moe’s method.The higher pedicle rotation grade had higher Cobb’s angle. Surgical treatment for scoliosis is indicated for the curve exceeding 40o. Posterior spinal fusion is the most commonly used technique in scoliosis surgery.Objective: To identify the correlation between the Cobb’s Angle and pedicle rotation in AIS after surgical treatment.Methods: The research design used in this study was Cross Sectional. The sample size of this study were 22 subjects using purposive sampling, the independent variable of this study was Cobb’s angle while the dependent variable was pedicle rotation. Spearman’s rank correlation was used to analyze the correlation between variable.Results: The spearman’s rank correlation revealed a significant correlation between the Cobb’s Angle and pedicle rotation in AIS after surgical treatment with the p 0,005 and r 0,462.Conclusion: This study demonstrates there is a significant correlation between Cobb’s angle and pedicle rotation in AIS after surgical treatment with medium strength.